"Perplexity Poll" Reveals American Consumers Befuddled by Business Documents
and Healthcare Communications

from Siegel & Gale

Vast numbers of Americans find insurance, financial, legal and healthcare documents difficult to understand, according to the "Perplexity Poll," a national survey sponsored by Siegel & Gale (www.siegelgale.com), the brand strategy firm that (1975) pioneered the use of plain English in business communications. The "Perplexity Poll" results show that confusing information leads to the deterioration of customer relationships, reduced brand loyalty and potential health problems.

Most and Least Perplexing - Documents and Information Sources

The five most perplexing information sources as rated by respondents are:

  • Insurance documents ("Letters from my health insurance company explaining what's covered and what isn't")

  • Financial documents ("Stock market information, mutual funds, and money market lingo")

  • Legal documents ("Anything in legalese like contracts, leases and loans")

  • Product instruction manuals ("Instructions for assembling things like grills or cabinets")

  • Computer-related documents ("Computer manuals or installation instructions for computer software")

The five commonly-used documents rated most "difficult to understand" are:

  • Mortgage applications (60%)

  • Health insurance benefits forms (57%)

  • Federal income tax returns (48%)

  • Newspaper stock market listings (46%)

  • Investment account statements (42%)

The five commonly-used documents receiving high ratings for being "easy to understand" are: payroll stubs, checking account statements, airplane safety instruction cards, credit card statements and catalog order forms.

"This survey reinforces the findings of previous Perplexity Polls over the past 20 years. Americans continue to find many of the most common and important documents are extremely confusing. When 60% of respondents rate mortgage applications and explanations of health insurance benefits 'difficult to understand,' it is shocking," said Alan Siegel, chairman of Siegel & Gale and one of the nation's foremost authorities on business communications.

"Despite all the business and government programs to improve disclosure and assist people in making informed decisions, a more educated and informed consumer population, and self-serving pronouncements from corporate America about building a meaningful dialogue with customers, vital business documents and medical instructions have shown little or no improvement in recent years," said Siegel.

"The degree of perplexity uncovered in the insurance, financial and legal sectors doesn't bode well for a population that is being asked to take responsibility for its retirement and healthcare decisions," said Siegel. "This should be a wake-up call for American business. By providing customers simpler, clearer information, companies can establish meaningful differentiation that creates stronger relationships and enhance brand loyalty."

Perplexity is Dangerous to Your Health

The consequences of perplexity can be extremely dangerous to the health of consumers, especially when confusion results in improper use of prescription or over-the-counter medications.

As a case in point, the survey explored perplexity in practice by asking respondents to read three types of healthcare-related information, a Children's Tylenol™ box, a Lipitor™ (Pfizer's cholesterol-lowering medication) patient information sheet provided by a major retail pharmacy chain, and a Medicare explanation of benefits form, and answer several questions.

When information is presented clearly, as on the Children's Tylenol box, the poll found people to be much more likely to read and understand the information, and most importantly, to follow directions correctly. Nine of ten (92%) respondents agreed the Children's Tylenol box "provides valuable information," 89% percent said they would "read it," and 76% correctly answered a question about maximum daily dosage (4x).

While 82% of those surveyed said the Lipitor product information sheet "provides valuable information," and 74% said they would "read it," nearly half (47%) found it "too complex," and more than one-third (36%) incorrectly answered a question about medicating after eating a grapefruit (wait one hour).

The most complex document of the three evaluated, the Medicare Part B Insurance Benefits form, fared the worst. While 72% said it "provides valuable information," and 67% said they would "read it," half (50%) said it is "too complex." When asked if patients pay a larger share of unassigned Medicare claims, 43% answered incorrectly (correct answer is "true").

"The results demonstrate that an alarmingly high percentage of consumers can't answer basic questions from product information on commonly used drugs and medical insurance benefits forms," said Siegel. "What is it going to take to get companies to present information that is clear, well organized and visually inviting?"

Perplexity Leads to Customer Dissatisfaction

The poll results show perplexity to be a key contributor to customer dissatisfaction. Among poll respondents who had purchased a product for $50 or more within 30 days and had contacted the manufacturer for help, 72% cited the lack of clear, understandable instructions as their primary reason for contacting the seller. More than one-third (34%) of those contacting customer support via telephone or online were "not satisfied" or only "somewhat satisfied." Most telling, 70% of those "not satisfied" or "somewhat satisfied" said they would "definitely not purchase another product" from that manufacturer or retailer.

"We believe that 'simple is smart,' and the Perplexity Poll results support this approach," said Siegel. "Few things differentiate a brand and build trust better than providing useful information with clarity and consistency. We encourage every organization to embrace this guiding philosophy and take the steps necessary to better organize, streamline and simplify their communications."


The Perplexity Poll is a quarterly survey sponsored by Siegel & Gale and conducted by Gelb Consulting Group. Each subsequent version of the poll will examine the issue of perplexity in specific industry sectors and assess its impact. This inaugural version of the poll was conducted in June 2004 among a random sample of U.S. consumers ages 18 and over. A total of 1,709 respondents completed the survey. The Perplexity Poll margin of error is ±3%.

About Siegel & Gale

Established in 1969, and today one of the world's leading brand strategy companies, Siegel & Gale continues to create innovative and iconic branding programs for such firms as 3M, Adobe, American Express, Boise, Caterpillar, Dell, Dow, ESPN, Kodak, Lehman Brothers, Lexus, Medtronic, Metropolitan Transit Authority (MTA), Norsk Hydro, Technicolor, and the U.S. Air Force. Since 1975, when it first simplified Citibank loan contracts, Siegel & Gale has been at the vanguard and the voice of the movement to bring plain English to business and government communications.

About Gelb Consulting Group, Inc.

Founded in 1965, Gelb Consulting Group helps companies grow revenues and improve marketing effectiveness by using market research to develop new products and strong brands.

The Perplexity Poll Summary of Results, with charts and graphs, is available for viewing or downloading (in PDF format) at www.siegelgale.com/perplexity.

The complete Perplexity Poll results are available upon request. Contact Peter Allen, Marketing Services Director, Siegel & Gale, 212.817.6676 or pallen@siegelgale.com.

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